Ontario-wide research atlas shows stable rates of head and neck cancers, except for rise in HPV-related throat cancer

A research atlas released today by the Institute for Clinical Evaluative Sciences (ICES) and Cancer Care Ontario shows that the provincial incidence rates for head and neck cancers have increased slightly, indicating that need for treatment for these cancers will likely grow as Ontario’s population ages.

This is the first comprehensive data published on head and neck cancers across Ontario in nearly two decades.

Using linked anonymized patient health data from across Ontario, this robust atlas of head and neck cancers presents information on surgery and related health services provided to Ontarians who were newly diagnosed with cancer of the oral cavity, larynx/hypopharynx or salivary gland between 2003 and 2010.

“Overall, the incidence rates for most head and neck cancers have been holding steady, meaning that as our population ages, we’re likely to see a rise in the need for care for these cancers since they predominantly affect people over the age of sixty,” says Antoine Eskander, a head and neck surgical resident at the University of Toronto who completed this work at ICES.

Among the key findings in the atlas are:

• Overall, the number of individuals with head and neck cancers in Ontario has increased from 10.9 per 100,000 people in 1993 to 11.6 per 100,000 people in 2010; some cancers have increased  in incidence (oropharynx and salivary gland) while others have decreased (larynx/hypopharynx).
• While many of the incidence rates have remained steady or declined slightly, there has been a significant annual increase of 13 per cent in the incidence of oropharynx cancers, which mirrors trends observed in the United States and Europe and is linked to the rise in the sexually transmitted human papillomavirus (HPV).
• There is a higher incidence of head and neck cancers in those with advanced age, particularly for people aged 65 years or older.
• The incidence rate for oral cancers is 20 percent higher in lower-income neighbourhoods, and incidence for larynx/hypopharynx cancers is 67 per cent higher in lower-income neighbourhoods.
• Patients over the age of 75 are less likely to undergo surgery (at 67 per cent compared to over 80 per cent for other age groups)
• There are regional differences in surgical approaches and access to palliative care depending on the LHIN of residence and LHIN of treatment.
• Hospitals and surgeons with higher-volume surgeries are associated with better outcomes for patients, with hospital volumes appearing more important than surgeon volumes. Every additional 25 cases performed by a hospital is associated with a 2.4 per cent improvement in survival.
• Head and neck cancer surgery has been largely regionalized to high volume centres in Ontario. Despite that, there is still variation in care which will be reduced by quality performance metrics and development of Disease Care Pathways, both of which are currently being developed by Cancer Care Ontario.

"By assessing variations that exist in access, treatment and outcomes, these important findings will allow Cancer Care Ontario’s Surgical Oncology Program, along with our partners, to identify opportunities for quality improvement across the province," comments Robin McLeod, vice president of clinical programs and quality initiatives at Cancer Care Ontario. "This atlas is an effective resource that will help ensure a consistent high-quality approach to head and neck cancer surgery across all care settings in Ontario.”

“Head and Neck Cancer Surgery in Ontario, 2003‒2010: An ICES Atlas” was published today online.

Author block: Antoine Eskander, Jonathan C. Irish, David R. Urbach, David P. Goldstein.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

Cancer Care Ontario – a division of CCO and the Ontario government’s principal cancer advisor – plays an important role in equipping health professionals, organizations and policy-makers with the most up-to-date cancer knowledge and tools to prevent cancer and deliver high quality patient care.  It does this by collecting and analyzing data about cancer services and combining it with evidence and research that is shared with the healthcare community in the form of guidelines and standards. It also monitors and measures the performance of the cancer system, and oversees a funding and governance model that ties funding to performance, making healthcare providers more accountable and ensuring value for investments in the system. Cancer Care Ontario actively engages people with cancer and their families in the design, delivery and evaluation of Ontario’s cancer system, and shares CCO’s mission of working together to improve the performance of Ontario’s cancer system by driving quality, accountability, innovation and value.

FOR FURTHER INFORMATION PLEASE CONTACT:

• Kathleen Sandusky
• Media Advisor, ICES
• [email protected]
• (o) 416-480-4780 or (c) 416-434-7763

• Cancer Care Ontario
• Phone: 1.855.460.2646
• Email: [email protected]